Quality of institutional care and early childhood development

Institutional rearing adversely affects children’s development, but the extent to which specific characteristics of the institutional context and the quality of care provided contribute to problematic development remains unclear. In this study, 72 preschoolers institutionalised for at least 6 months were evaluated by their caregiver using the Child Behavior Checklist and the Disturbances of Attachment Interview. Distal and proximate indices of institutional caregiving quality were assessed using both staff reports and direct observation. Results revealed that greater caregiver sensitivity predicted reduced indiscriminate behaviour and secure-base distortions. A closer relationship with the caregiver predicted reduced inhibited attachment behaviour. Emotional and behavioural problems proved unrelated to caregiving quality. Results are discussed in terms of (non)-shared caregiving factors that influence institutionalised children’s development.

Report on alternatives to institutional care : Public Law 99-576, section 235 and House and Senate Veterans Affairs Committees' request of June 20, 1986.

Cover title.

Tradition, Change and Variation : Past and Present Trends in Public Old-age Care

The general aim of this dissertation is to describe and analyse how public old-age care in Sweden has developed and changed during the last century. The study applies a provider perspective on how care has been planned and professionally carried out. A broader social policy perspective, studying old-age care at central/national as well as local/municipal level, is also developed. A special focus is directed at the large local variation in care and services for the elderly. The empirical base is comprised of official documents and other public sources, survey data from interviews with elderly recipients of public old-age care, and official statistics on publicly financed and controlled old-age care and services. Study I addresses the development of old-age care in Sweden during the twentieth century by studying an important occupation in this field – the supervisors and their professional roles, tasks and working conditions. Throughout, the roles of supervisors have followed the prevailing official policy on the proper way to provide care for elderly people in Sweden; from poor relief at the beginning of the 1900s, via a generous level of services in the 1960s and 1970s, to today’s restricted and economy-controlled mode of operation. Study II describes and compares two main forms of public old-age care in Sweden today, home help services and institutional care. The care-load found in home-based care was comparable to and sometimes even larger than in service-homes and other institutions, indicating that large care needs among elderly people in Sweden today can be met in their homes as well as in institutional settings. Studies III and IV analyse the local variation in public old-age care in Sweden. During the last decades there has been an overall decline in home help services. The coverage of home help for elderly people shows large differences between municipalities throughout this period, and the relative variation has increased. The local disparity seems to depend more on historical factors, e.g., previous coverage rates, than on the present municipal situation in levels of need or local economy and politics. In an introductory part the four papers are linked together by an outline of the demographic situation and the social policy model for old-age care in Sweden. Trends that have been apparent over time, e.g. professionalisation and market orientation, are traced and discussed. Conflicts between prevailing ideologies are analysed, in regards to for instance home-based and institution-based care, social and medical culture, and local and central levels of decision-making. ’Welfare municipality’, ‘path dependency’, and ‘decentralisation’ are suggested as a conceptual framework for describing the large and increasing local variations in old-age care. Finally, implications of the four studies with regard to old-age care policy and further research are discussed.

Costs of managing urinary and faecal incontinence in a sub-acute care facility: A "bottom-up" approach

Aims: To measure accurately the direct costs of managing urinary and faecal incontinence in the sub-acute care setting. Materials and Methods: Prospective observational study was undertaken in two sub-acute care units in a metropolitan hospital. A consecutive series of 29 consecutive patients with urinary and/or faecal incontinence, who were in-patients in a geriatric rehabilitation or subacute neurologic unit underwent routine timed voiding protocol, as per usual care. Face-to-face bedside recordings of all incontinence care, with detailed cost analysis, were undertaken. Results: A total of 3,621 occasions of continence care were costed. The median time per 24 hr spent caring for incontinence per patient was 109 min (interquartile range 88-140). Isolated urinary incontinence episodes occurred in 28 patients (96.5%), mixed urinary/faecal incontinence episodes observed in 79.3%, and episodes of pure faecal incontinence were seen in 62%. The median costs of incontinence care in the sub-acute setting was $49AU per 24 hr, the major share ($41) spent on staff wages. The incontinence tasks of toileting assistance, pad changes, bed changes and catheter care were spread evenly across the three 8 hr shifts of duty. Conclusions: As our population demographics include an increasingly greater portion of the elderly, for whom long term institutional care is becoming relatively more scarce, provision of care in the sub-acute unit that may allow rehabilitation and return to home warrants scrutiny. This is the first study that delineates the costs of managing urinary and faecal incontinence in the sub-acute care setting. Such costs are substantial and place a heavy burden upon night-time carets. (C) 2004 Wiley-Liss, Inc.

Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989-1990

Background and Purpose-Few reliable estimates of the long-term functional outcome after stroke are available. This population-based study aimed to describe disability, dependency, and related independent prognostic factors at 5 years after,a first-ever stroke in patients in Perth, Western Australia. Methods-All individuals with a suspected acute stroke who were resident in a geographically defined region (population, 138 708) of Perth, Western Australia, were registered prospectively and assessed according to standardized diagnostic criteria over a period of 18 months in 1989 to 1990. Patients were followed up prospectively at 4 and 12 months and 5 years after the index event. Results-There were 370 cases of first-ever stroke, and 277 patients survived to 30 days. Of these early survivors, 152 (55%) were alive at 5 years, and among those who were neither institutionalized (n=146) nor disabled (n=129) at the time of their stroke, 21 (14%) were institutionalized in a nursing home, and 47 (36%) were disabled. The most important predictors of death or disability at 5 years were increasing age, baseline disability defined by a Barthel Index score of <20/20 (odds ratio [OR], 6.3; 95% confidence interval [CI], 2.7 to 14), moderate hemiparesis (OR, 2.7. 95% CI, 1.1 to 6.2), severe hemiparesis (OR, 4.5; 95% CI, 1.1 to 19), and recurrent stroke (OR, 9.4; 95% CI, 3.0 to 30). A low level of activity before the stroke was a significant predictor of institutionalization, and subsequent recurrent stroke was a consistent, independent predictor of institutionalization, disability, and death or institutionalization, increasing the odds of each of these 3 adverse outcomes by 5- to 15-fold. Conclusions-Among 30-day survivors of first-ever stroke, about half survive 5 years; of survivors, one third remain disabled, and I in 7 are in permanent institutional care. The major modifiable predictors of poor long-term outcome are a low level of activity before the stroke and subsequent recurrent stroke. Efforts to increase physical activity among the elderly and to prevent recurrent stroke in survivors of a first stroke are likely to reduce the long-term burden of cerebrovascular disease.

Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study

Background and Purpose-Limited information exists on the long-term prognosis after first-ever stroke. We aimed to determine the absolute frequency of first recurrent stroke and disability and the relative frequency of recurrent stroke over 10 years after first-ever stroke in Perth, Western Australia. Methods-For a 12-month period beginning February 1989, all individuals with suspected acute stroke or transient ischemic attack who lived in a geographically defined and representative region of Perth were registered prospectively. Patients with a definite first-ever stroke were followed up 10 years after the index event. Results-Over 10 years of follow-up, the cumulative risk of a first recurrent stroke was 43% (95% confidence interval [CI], 34 to 51). After the first year after first-ever stroke, the average annual risk of recurrent stroke was approximate to4%. Case fatality at 30 days after first recurrent stroke was 41%, which was significantly greater than the case fatality at 30 days after first-ever stroke (22%) (P=0.003). For 30-day survivors of first-ever stroke, the 10-year cumulative risk of death or new institutionalization was 79% (95% CI, 73 to 85) and of death or new disability was 87% (95% CI, 81 to 92). Conclusions-Over 10 years of follow-up, the risk of first recurrent stroke is 6 times greater than the risk of first-ever stroke in the general population of the same age and sex, almost one half of survivors remain disabled, and one seventh require institutional care. Effective strategies for prevention of stroke need to be implemented early, monitored frequently, and maintained long term after first-ever stroke.

Adolescente e ato infracional : uma investigação acerca da medida socioeducativa de internação na cidade do Recife-PE

RESUMO: Este estudo procura avaliar a Medida Socioeducativa de Internação decretada a adolescentes autores de ato infracional na Cidade do Recife no ano de 2009. É um trabalho de grande importância para a sociedade brasileira, sobretudo, no que diz respeito ao combate à violência juvenil, à criminalidade em geral, e à construção de um mundo mais justo e solidário. Escolhemos a Cidade do Recife, Capital do Estado de Pernambuco, localizada na região Nordeste do Brasil, para ser o local da nossa pesquisa, por ser esta uma das mais violentas cidades do país. No decorrer desta pesquisa fizemos ainda uma breve análise do cenário sociológico da adolescência na Cidade do Recife. Em seguida estudamos o cenário jurídico dos adolescentes autores de ato infracional com base no Estatuto da Criança e do Adolescente – Lei nº 8.069/1990, analisando a evolução histórica do tratamento legal dispensado a estes jovens, abordando o conceito de adolescente e ato infracional, e investigando as Medidas Socioeducativas previstas na legislação brasileira, sobretudo, a Medida de Internação, pelo fato de ser a mais grave delas. Assim, além investigarmos através de dados estatísticos o quantitativo por gênero de adolescentes autores de ato infracional aos quais foram decretadas Medida de Internação, observamos os tipos de atos infracionais mais praticados. Intentamos, dessa forma, questionar a violência juvenil e o modo como a sociedade e as instituições envolvidas têm tratado a questão. Para tanto, foram realizadas entrevistas com servidores da Fundação de Atendimento Socioeducativo- FUNASE, entidade que trabalham diretamente com a reeducação de adolescentes autores de ato infracional submetidos à Internação na Cidade do Recife, para analisar como estão sendo aplicadas essas medidas. ABSTRACT: This study aims to evaluate the Socioeducational Measure of Internation decreed to transgressor teenagers in the City of Recife at the year 2009. This study has a big importance to Brazilian society, above all, because focalize the combat of the juvenile violence in Recife, Capital of the State of Pernambuco on the northwest of the Brazil, one of the most violent city of Brazil. During this investigation, was done a brief analysis of sociological scenery of teenage in this City. It was studied too, the juridical scenery of teenagers that committed any kind of transgression, based on the Statue of Child and the Adolescent- law n° 8.069/1990, analyzing the historical evolution of lawful treatment put into practice to this people, using the concept of adolescent and infracional act, and observing the social and educative punishment in the penal justice system of Brazil, and detaching the measure of internation, that is the gravest form of punishment. So, in this study it was investigated the quantity of transgressors adolescents based in gender and the kinds of transgression most practiced by them which results on internation measure decreed. This way, the purpose of this study is discuss about young violence and the way that society and institutions have faced this question. For this, it was realized interviews with Foundation of Socioeducative Attendance – FUNASE workers, that work directly with re-education of adolescents that committed any transgression and were submitted to internation punishment, in order to analyze how are being applied these measures.

A participação das crianças em lares de infância e juventude: representações e práticas. um estudo de caso.

Dissertação de 2º Ciclo conducente ao grau de Mestre em Ciências da Educação - especialização em Educação Social e Intervenção Comunitária

“Os crescidos vão para o colo dos crescidos … é só os crescidos!” direitos de participação das crianças em centros de acolhimento temporário

Dissertação apresentada à Escola Superior de Educação de Lisboa para a obtenção de grau de mestre em Ciências da Educação, Especialização em Intervenção Precoce

Crescer com os desafios. Uma intervenção psicossocial em acolhimento institucional

O acolhimento institucional é concebido como uma medida com vista à promoção e proteção de crianças e jovens em risco. Esta resposta concretiza-se na capacidade de resposta dos Lares de Infância e Juventude e da especialização dos profissionais, tendo em conta as diferentes necessidades e caraterísticas dos educandos. A necessidade de compreender os jovens institucionalizados, como sujeitos participativos e com voz nas decisões que afectam as suas vidas, assume um especial significado para estes sujeitos se considerarmos que o impacte da institucionalização nas suas vidas influencia o seu desenvolvimento e a relação com os diferentes contextos nos quais se inserem. O presente Relatório reflete o desenvolvimento de um Projeto de investigação posicionado metodologicamente na Investigação-Acção Participativa, intitulado “Crescer com os desafios”, desenvolvido com jovens e educadores do LIJ. Este projeto teve como grande finalidade “Potenciar o “empowerment” dos jovens do LIJ no contexto institucional e escolar, favorecendo uma aprendizagem centrada nas suas necessidades e valorização do seu próprio processo educativo, através de uma intervenção psicossocial”. A finalidade deste Projeto e todos os objetivos propostos foram ao encontro dos problemas e necessidades priorizados pelos participantes, propondo-se, a partir de um conjunto de ações e atividades, alcançar a mudança. Os resultados deste Projeto revelam-se significativos, uma vez que promoveram um processo de reflexão e de partilha acerca dos desafios do acolhimento institucional, apontando para a necessidade de traçar linhas de intervenção adequadas às necessidades e ao percurso escolar de cada jovem.

Blogues. Reflexões em ambientes de e-learning pela prática

Esta dissertação tem como referência o trabalho que realizamos no Ministério Público de Pernambuco, onde temos a oportunidade de observar e conhecer os serviços de acolhimento institucional para crianças e adolescentes, bem como da atuação de outros atores que atuam nesta área de medida protetiva, no Estado de Pernambuco. Aqui articularemos esta prática com os achados históricos, teóricos e legais vigentes em busca de estabelecer estratégias e ações de intervenção, para atuarmos neste contexto que geograficamente tem pontos de articulações distantes. Buscamos neste estudo analisar todos os lados de uma construção para a execução de uma plataforma que possa oferecer um serviço de capacitação em e-learning aos profissionais que atuam na área protetiva. Para isto precisaremos identificar o perfil destes profissionais e reconhecer que se, mesmo diante das dificuldades de sua profissão, eles se dispõem em participar de capacitação on-line voltado para a prática. Analisou-se o blog como um sistema adequado para se trabalhar com e-learning recorrendo à literatura para identificar quais os critérios, parâmetros e indicadores que faz um blog institucional de qualidade. Dando corpo ao nosso intento, faremos um percurso pelas teorias da aprendizagem buscando consistência para investigarmos se novas abordagens como o Conectivismo, responde ou não aos nossos anseios de formação continuada na prática e pela prática.

Responsividade sensível da cuidadora e processamento de expressões faciais emocionais em crianças institucionalizadas: um estudo com potenciais evocados

Dissertação de mestrado em Psicologia Aplicada

Entourage des patients âgés avec une pathologie mentale [Carers of elderly patients suffering from mental disorders]

Mental disorders in the elderly lead their families to stand in and adopt a variety of roles before institutional care takes over. These pathologies carry a high risk of suffering for families and distress for professional caregivers. Thus, the psychological burden endured by the proxies of an elderly depressed patient, or of one who has committed suicide, or of patient suffering from dementia needs special attention and, in some cases, professional care. The discussion of these paradigmatic situations in this manuscript will be extended by a paragraph on specific stakes raised by alcoholic patients living in nursing homes. It will stress the complexity and requirements of professionalism when approaching the familial and professional circle of the elderly psychiatric patient.

Representaciones y significados acerca de la vejez institucionalizada

Este trabajo de investigación se enmarca en los estudios dedicados al conocimiento del significado que se le atribuye a la vejez en nuestra sociedad. El ámbito de interés se centra en la vida de las personas mayores dentro y fuera de las instituciones geriátricas con el objeto de comprender en qué medida estos factores pueden llegar a condicionar el imaginario acerca de la vejez. Más específicamente la idea central, que orienta la investigación y delimita claramente el tema de trabajo, se sintetiza en la siguiente pregunta clave: ¿cómo incide la institucionalización de los ancianos y las ancianas en la concepción y autopercepción de la vejez?

Vanhukset ja pitkäaikainen laitoshoito

Lectio praecursoria väitöstilaisuudessa (Helsingin yliopisto) 24.1.1998; Väitöskirjan nimi: Long-term institutional care among Finnish elderly population